Preoperative Nursing

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Author:
Danette
ID:
144728
Filename:
Preoperative Nursing
Updated:
2012-04-08 22:59:32
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Exam One
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Preop
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  1. Preoperative nursing definition
    The wide variety of nursing activities carried out before, during, & after surgery
  2. Preoperative phase
    • Begins when decision to have surgery is made & ends when client is transferred to operating room.
    • Preop visit
    • Outpatient, ambulatory care unit, same day surgery
    • Inpatient - admitted before surgery - like traction
  3. Surgery classifications
    • Based on urgency
    • Based on degree of risk
    • Based on purpose
  4. Surgery Classifications - Based on Urgency
    • Elective - delay of surgery, has no ill effects (hernia repair)
    • Urgent - usually done within 24-48 hours (gallbladder removal)
    • Emergency - done immediately for trauma & to preserve life (hemorrhage)
  5. Surgery Classifications - Based on Degree of Risk
    • Major - may be elective, urgent or emergency, done to preserve life, restore function, or improve/maintain health (colostomy, hysterectomy, amputation)
    • Minor - primarily elective, restore function, remove skin lesions, correct deformaties, teeth extraction, cataract extraction
  6. Surgery classification - Based on purpose
    • Ablative - to remove diseased body part (appendectomy)
    • Diagnostic - to make or confirm diagnosis (breast biopsy)
    • Palliative - to relieve or reduce intensity or pain of an illness but is not curative (colostomy)
    • Reconstructive - to restore function to traumatized or malfunctioning tissue (scar revision / skin graft)
  7. *Informed Consent
    Client's voluntary agreement to undergo a particular procedure or treatment having received the following information in understandable words by physician
  8. *Informed Consent Info
    • Description of treatment, risks, & reason for procedure or surgery
    • Explanation of risks including potential outcomes, potential damage, & disfigurement or death & how often they occur
    • Potential alternative treatment
    • Name of person qualified to perform surgery
    • Explanation that the client has the right to refuse and that consent can be withdrawn
  9. Informed Consent - Legal document
    The person responsible for obtaining the informed consent is the one who is performing the surgery or procedure, usually the MD
  10. Informed Consent - Nurse's Role
    • Signing as a witness
    • Making sure the client is alert, oriented, & understands what is being signed
    • Client advocate
    • *Not legal if client is confused, unconscious, medicated, or mentally incompetent
    • Client should sign own consent
    • Spouse can give permission, next of kin, parents or legal guardians
    • Consent not needed inf emergency & can't find any kin.
  11. Informed Consent - More about Consents
    • Needs 2 witnesses if consent over the phone to sign
    • If can't read, must read all to pt
    • If can't write, they put an X & 2 people witness it
    • If blind - 2 people as well
  12. Nursing process - assessment of preoperative client
    • Anxiety
    • Assessment - Medications
    • Body image
    • Client-family understanding
    • Cultural concerns
    • Fears
    • Nutrition
    • Previous surgeries
    • Spiritual issues
    • Support system
    • Therapeutic communication
  13. Nursing process - Assessment of preoperative client - Assessment Medications
    • Antibiotics
    • Anticoagulants
    • Anticonvulsants
    • Cardiac
    • Coritcosteroids
    • Diuretics
    • Herbal Therapies
    • Insulin
  14. Assessment - Medications
    • Antibiotics - Mycin can cause respiratory paralysis with certain anesthetics
    • Anticoagulants - ASA, coumadin may participate hemorrhage
    • Anticonvulsants - dilantin may alter metabolism of anesthetic agents
    • Cardiac - may cause decrease in heart contractibility & peripheral vasodialtion - could have changes in BP
    • Corticosteroids - prednisone - abrupt withdrawal may cause cardiovascular collapse
    • Diuretics - lasix can cause electrolyte imbalances
    • Herbal therapies - ginsing, geiko - affects platelet activity & can increase postop bleeding
    • Insulin - NPO patient, IV with glucose, insulin dosages need to be adjusted
  15. Allergies
    Nurses are responsible for identifying allergies (med, tape, iodine, latex) allergy band & label in front of chart with allergy sticker - what is reaction?
  16. Smoking
    • Increases risk for pulmonary complications
    • Secretions are retained by patients during anesthesia, a smoker has decreased ciliary movement, increased mucous secretion making secretions difficult to clear
  17. ETOH (alcohol) use/IV drug use
    • Can alter clients response to anesthesia
    • Withdrawals
  18. Changes of aging/Surgical client
    Cardiovascular
    • Decreased cardiac output
    • *Obtain baseline vital signs
    • Decreased peripheral circulation
    • *Assess peripheral pulses
  19. Changes of aging/Surgical client
    Respiratory
    • Decreased vital capacity - obtain record & baseline
    • Decreased couch reflex
    • Decreased chest expansion - teach cough & deep breath
  20. Changes of aging/Surgical client
    Renal
    • Decreased renal blood flow
    • Decreased bladder capacity
    • Altered metabolism & excretion of meds & anesthesia
    • Monitor labs (BUN & creatinine)
    • *I&O
    • *Fluid overload dehydration
  21. Changes of aging/Surgical client
    Neuro
    • Sensory deficit
    • Decreased reaction time
    • Reduced thermoregulation ability
    • *Allow more time for answers
    • *Safety measures
    • *Monitor temp
  22. Changes of aging/Surgical client
    Musculoskeletal
    • Increased incident of deformities related to arthritis & osteoporosis
    • *Encourage ambulation
    • *Assess mobility issues
  23. Lab/Diagnostics - Done 24-48 hours prior to surgery
    • Nurses role - ensure tests were done, results were recorded before surgery & abnormal findings were reported
    • CXR - chest x-ray
    • EKG - heart damage?
    • CBC - H&H
    • Electrolytes
    • UA
    • Clotting factors - PT, PTT, INR
    • Autologous blood donations - dontate own blood
    • Type & Cross match -
  24. Preoperative teaching - improves clien't outcome after surgery. VERY IMPORTANT
    • Deep breathing/coughing - every hour until ambulatory
    • Incentive spirometer - 10x hour
    • Leg exercises/Ted hose/Intermittent pneumatic compression devices (sequentials) - promotes circulation & venous return
    • Ambulation
    • Pain management
  25. Preoperative Checklist
    • Check ID band
    • Bath before surgery - if inpatient
    • Outpatient, give soap to wash
    • Dentures removed
    • Eyeglasses off
    • Keep hearing aid in
    • MD & nurse will mark site
    • Meet families needs
    • Document interventions
    • Move onto gourney & transfer to OR
  26. Nursing Diagnoses
    • Anxiety R/T effect of surgical procedure on ability to function as a primary wage earner AEB clients statement (I feel nervous about being off work).
    • Risk for infection R/T surgical incision
    • Risk for ineffective airway clearance R/T 30-year history of smoking

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